A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations

Abstract

Study Objectives The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children. Methods A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1-18 years-old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims. Results Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g., noise, staff interruptions), most interventions targeted the child-level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components. Conclusions Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as a main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.

Sleep and Circadian Disruptors: Unhealthy Noise and Light Levels for Hospitalized Pediatric Stem Cell Transplant Patients

“…16 The high noise levels are consistent with a recent review and are a well-known issue for inpatients. 5 Humans can become accustomed to a persistently noisy environment so long as it is constant -variability may drive night wakings. 12,14,19 By two different metrics, children in our study were exposed to exceedingly disruptive noise: 3.4 noise spikes >80 dB (roughly equivalent to a gas-powered lawnmower 20 ) and 5.6 SLCs >17.5 dB per night.…”

“…21,25,26 Although environmental factors are known to be the most common sleep disruptors, the majority of sleep-promoting interventions target individuals' behaviors, not their environments. 5 Due to the known challenges with sustaining interventions targeting patients or providers, institutions should make systematic changes that prioritize sleep and circadian function (e.g., reducing overnight noise or consolidating procedures 7,27,28 ). 29 Almost all section chiefs of hospital medicine rate patient sleep as important, but fewer than half of their hospitals have adopted sleep friendly practices.…”

“…Noise and light are frequent disruptors of sleep and circadian health in pediatric hospital rooms. 5 Noise often spikes during the night on pediatric oncology units as a result of staff room entries, medication administrations, and alarms. [6][7][8] Irregular and "unnatural" light-dark cycles can cause circadian disruptions.…”

Gaps in Parental Understanding of Sleep Disturbances During Maintenance Therapy for Pediatric Acute Lymphoblastic Leukemia

“…Sleep disturbance is one of the most common challenging symptoms for pediatric cancer patients, both during and following treatment. These issues often develop during the intense initial stages of chemotherapy treatment (Steur, Kaspers, et al, 2020), exacerbated by a hospital environment and medical procedures that are not conducive to good sleep (Fidler et al, 2022; Lee et al, 2017). For children with ALL whose chemotherapy treatment lasts for 2 to 3 years, their sleep often continues to suffer throughout therapy due to chemotherapy regimens that include pulsed administration of glucocorticoids (particularly dexamethasone) that are highly disruptive to children's sleep/wake patterns (Daniel, Li, et al, 2016; Hinds et al, 2007; Matthews et al, 2014; Rogers et al, 2014; Steur, Grootenhuis, et al, 2020).…”

Sleep and circadian disruptors: Unhealthy noise and light levels for hospitalized pediatric patients

“…Noise and light are known disruptors of sleep and circadian health for hospitalized patients in pediatric hospitals 1 . For example, noise often spikes at night on inpatient units as a result of alarms, medication administrations, and room entries, which can average 7–12 entries per night 1,2 . Irregular and “unnatural” light–dark cycles that are not aligned with natural light patterns can cause circadian disruptions 3 .…”